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Director, Commercial Reimbursement - Remote, USA

3 weeks, 5 days ago
United States
Full-time
Lead
Sales Operations
Sales and Business Development
Apply Now
Calyxo

Calyxo

Calyxo is dedicated to enhancing the treatment of kidney stones through its innovative CVAC System, which combines multiple advanced techniques into a single, minimally invasive procedure for effective stone clearance.

Health Care Providers & Services
11-50
Founded 2016
$47M raised
View All Jobs 13

Description

  • Develop and execute commercial reimbursement strategies aligned with company objectives and growth plans.
  • Lead engagement with national, regional, and local commercial health plans, including medical directors and policy teams.
  • Drive efforts to influence, establish, or revise commercial payer medical policies and challenge non-coverage or restrictive utilization decisions.
  • Lead escalation of payer policy disputes, coverage barriers, underpayment issues, and other high-impact reimbursement challenges.
  • Serve as the primary commercial reimbursement contact for payer negotiations and senior-level escalations.
  • Coordinate and support peer-to-peer discussions, appeals, and reconsiderations with clinical and provider stakeholders.
  • Support the identification and development of physician champions and partner with providers on reimbursement issues across outpatient sites of service.
  • Provide direct people management and leadership for the Market Access Manager team, including coaching, performance expectations, and development.
  • Establish standardized processes, tools, and best practices to ensure consistent field execution and operational effectiveness.
  • Collaborate with Commercial, Sales, Medical Affairs, Legal, Compliance, and Finance teams to support integrated reimbursement planning and launch readiness.
  • Develop metrics and reporting to assess reimbursement performance, identify risk and opportunity, and inform strategic prioritization.

Requirements

  • Bachelor’s degree required; advanced degree preferred in health policy, health services administration, or public health.
  • Minimum 8 years of progressively responsible experience in reimbursement, market access, or payer relations within medical devices or healthcare.
  • Experience at a Senior Manager or Director level with accountability for team performance and development.
  • Demonstrated experience working with commercial health plans, including policy review, coverage advocacy, and payer negotiations.
  • Strong working knowledge of commercial health plan prior authorization, claims processing, and appeals in outpatient settings.
  • Experience using commercial payer data sources and claims datasets to support coverage analysis, denial trends, and reimbursement decisions.
  • Familiarity with coding, payment, and site-of-service considerations across multiple care settings.
  • Experience partnering with physicians to support payer discussions or appeal strategies.
  • Excellent oral presentation, technical, written, and communication skills.
  • Proficiency with Microsoft Office, including Word, Excel, Outlook, and PowerPoint.
  • Ability to travel up to 40%.
  • Remote work location; full-time employment.
  • Legal authorization to work in the United States is required.
  • Must maintain up-to-date hospital credentialing requirements, including required vaccinations and immunizations.
  • Must be able to sit for up to 8 hours per day.

Benefits

  • Competitive base salary range of $210,000 to $225,000.
  • Variable incentive plan.
  • Stock options.
  • Employee benefits package including 401(k), healthcare insurance, and paid vacation.
  • Remote work arrangement.
  • Opportunity to work with an experienced, high-achieving, diverse team.
  • Opportunity to grow through constant learning and dynamic challenges.

Interested in this position?

Apply directly on the company website

Apply Now

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